| NPI | 1245222330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A61442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 12846R) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-12-09 |