| NPI | 1154982130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A179035) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT218082) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2022-09-19 |