| NPI | 1700841830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2001027313) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2016-01-08 |