| NPI | 1083697007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C132666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 220489) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2020-09-09 |