| NPI | 1639437981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A13308) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 252638) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2021-07-28 |