| NPI | 1679917280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A22510) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS17139) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2025-01-06 |