| NPI | 1528385002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A13678) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS015304) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2015-06-01 |