| NPI | 1730210105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G53290) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G53290) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-04-16 |