| NPI | 1134121049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A89808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 43437-020) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2018-02-06 |