| NPI | 1669829032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A166325) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301109386) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2021-09-20 |