| NPI | 1245499078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C165064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 070199) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2021-10-05 |