| NPI | 1255610424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A155148) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101256404) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2023-09-12 |