| NPI | 1639597701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 57274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A159318) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2020-04-14 |