| NPI | 1639464316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 258176) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-247854) |
| 207R00000X Internal Medicine (Licence: CA A150046) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-07-08 |