| NPI | 1114343209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 009977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A15719) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2023-06-01 |