| NPI | 1063484053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301061429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301061429) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-05-24 |