| NPI | 1225012016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 307621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G83310) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2019-01-02 |