| NPI | 1316938764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R9D52) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G57847) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2019-02-08 |