| NPI | 1720340805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A13835) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT014864) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2018-02-27 |