| NPI | 1336244904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C54556) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D64675) |
| 207R00000X Internal Medicine (Licence: NC 2006-01515) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2018-01-25 |