| NPI | 1861835035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 18383) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A134571) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2018-04-10 |