| NPI | 1639175581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A45180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A451480) |
| 207R00000X Internal Medicine (Licence: CA A045148) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2014-12-11 |