| NPI | 1639308075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-01164) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A107357) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2026-01-05 |