| NPI | 1083720130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C192052) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 20040216) |
| 207R00000X Internal Medicine (Licence: NE 29612) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2024-01-26 |