| NPI | 1306370705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 19016) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 008420) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-08-18 |