| NPI | 1982787057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A34704) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A34704) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-05-02 |