| NPI | 1255828869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 200068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD474482) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2024-12-26 |