| NPI | 1952756017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A160481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 276356) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2020-07-28 |