| NPI | 1578554226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A94741) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 38707) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2014-05-28 |