| NPI | 1184063299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A14254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116026158) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2017-11-03 |