| NPI | 1821220930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C188372) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 61994-20) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2023-10-18 |