| NPI | 1720064488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A65656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A656500) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2020-03-09 |