| NPI | 1912102922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A109545) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT186912) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2021-12-15 |