| NPI | 1508388380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 82400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A166544) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2023-12-20 |