| NPI | 1235115635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A85006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA a08506) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2020-06-12 |