| NPI | 1083024087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2017025862) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2017025862) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2020-08-17 |