| NPI | 1639480247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C167686) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL32972) |
| 207R00000X Internal Medicine (Licence: NC 2013-01695) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2021-05-27 |