| NPI | 1104026319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 005220) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 242526) |
| 208D00000X General Practice (Licence: AZ 005220) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2018-07-24 |