| NPI | 1184800328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101254695) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A102914) |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2020-06-30 |