| NPI | 1952694887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301119108) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 132162) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2020-02-25 |