| 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 |