| NPI | 1164874368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 13667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10736) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2024-03-11 |