| NPI | 1568628725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A120405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2011011825) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2021-12-02 |