| NPI | 1255740791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 25441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116027608) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2019-07-10 |