| NPI | 1902392665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 18032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019038358) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2021-08-20 |