| NPI | 1215551858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 190940) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 190940) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-10-10 |