| NPI | 1881900629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A66655) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 40962) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2015-11-11 |