| NPI | 1710237847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 174586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 15963) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2022-03-10 |