| NPI | 1497168074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A147848) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-259358) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2020-06-03 |