| NPI | 1578593521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A98657) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0062322) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-01-08 |