| NPI | 1811048291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52417) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 43778) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2017-02-28 |