| NPI | 1124559430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD H94264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A17019) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-09-06 |