| NPI | 1194104703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 61736) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A158028) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2020-12-11 |