| NPI | 1861500274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD24398) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C53874) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2021-01-29 |