| NPI | 1558867002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA a177708) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME142411) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2025-11-18 |