| NPI | 1184658973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A54295) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 153935) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-11-14 |