| NPI | 1396056610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A126568) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 052111) |
| 208D00000X General Practice (Licence: CA A126568) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2021-03-23 |