| NPI | 1639122815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 67699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A70749) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-01-13 |