| NPI | 1639583438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A150360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D85382) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2022-08-02 |