| NPI | 1689160517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A173611) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315094209) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2021-09-22 |