| NPI | 1629113402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA c138870) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 34311) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2022-07-21 |