| NPI | 1659750560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C194706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 19473) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-04-01 |