| NPI | 1942648621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C195719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 28032) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2024-07-31 |