| NPI | 1750841193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A22310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR DO210477) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-04-21 |