| NPI | 1326073081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C54755) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD429698) |
| 207R00000X Internal Medicine (Licence: WA MD60190998) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-11-29 |