| NPI | 1669587341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A105410) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 220620) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2017-04-19 |