| NPI | 1124607379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A183778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA PTL6700) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-11-26 |