| NPI | 1952565301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A12274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101017957) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2020-05-20 |