| NPI | 1538447677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A113390) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD198178) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2020-08-04 |