| NPI | 1902835317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C147049) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301087338) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2017-05-12 |