| NPI | 1356897680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 162542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301110772) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2024-04-30 |