| NPI | 1801163183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A120182) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA To Be Obtained) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2021-12-01 |