| NPI | 1699882365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A50069) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A50069) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-10-19 |