| NPI | 1285043539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A147150) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN20190) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2021-11-18 |