| NPI | 1639584287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A161031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2017-01699) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2019-08-06 |