| NPI | 1093866469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C55573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 10827) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2020-02-25 |