| NPI | 1174948012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 154828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101259916) |
| Enumeration Date | 2014-03-01 |
| Last Update Date | 2024-07-02 |