| NPI | 1396128146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A156189) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209311) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2023-11-29 |