| NPI | 1770670713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A110080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2006027970) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-08-31 |