| NPI | 1902105737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A127893) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR T2014-095) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2016-08-15 |