| NPI | 1194952010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A118944) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MDR-5679) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2020-10-21 |