| NPI | 1912012824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A98194) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA md427048) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2021-11-22 |