| NPI | 1245215870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G49187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD19131) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2023-07-03 |