| NPI | 1609803048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G159334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD034000E) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-10-15 |