| NPI | 1457617714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A162444) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME122189) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2020-03-02 |