| NPI | 1780643270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C53594) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 23181) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2023-03-07 |