| NPI | 1992715155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A113015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 057628) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2023-07-13 |