| NPI | 1619059748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A66437) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A66437) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2015-12-18 |