| NPI | 1063827335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2017022377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-04770) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2022-07-21 |