| NPI | 1679992325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 17040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A140027) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-11-01 |