| NPI | 1205827623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A64108) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 8382) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2018-06-08 |