| NPI | 1942368907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C50733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 7570) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2017-01-20 |