| NPI | 1568881290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 139690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 338800) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2024-11-17 |