| NPI | 1235427055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A109274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM RS2013-0885) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2021-12-13 |