| NPI | 1306259809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A144707) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-02077) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-07-22 |