| NPI | 1568773448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A12717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101018920) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2026-03-26 |