| NPI | 1710931019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G88534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 25495) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2020-10-30 |