| NPI | 1760777627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 33366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A116924) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2022-03-30 |