| NPI | 1649219833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A99250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 23216) |
| 207R00000X Internal Medicine (Licence: SC 26725) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-01-04 |