| NPI | 1508260340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 50641) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A147804) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2021-06-30 |