| NPI | 1659719755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A143586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103240) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2016-09-02 |