| NPI | 1073142659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A203912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD215330) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-04-04 |