| NPI | 1063450344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 6258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A21994) |
| 207R00000X Internal Medicine (Licence: NE 11398) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-07-21 |