| NPI | 1396905402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A#110440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT#189998) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2015-12-07 |