| NPI | 1982990370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A152589) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0078844) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2020-04-22 |