| NPI | 1639276140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A94134) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 35650) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2018-03-17 |