| NPI | 1215529680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A205887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA PTL14130) |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2026-06-26 |