| NPI | 1932365780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A128120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2007005070) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2014-11-11 |