| NPI | 1205891942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 82992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 82992) |
| 207R00000X Internal Medicine (Licence: WV 1955) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2020-12-01 |