| NPI | 1720026271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A70434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2018-0832) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2021-11-11 |