| NPI | 1063479244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200400367) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A67702) |
| Enumeration Date | 2006-04-30 |
| Last Update Date | 2023-05-20 |