| NPI | 1265660799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 067289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL31759) |
| 207Q00000X Family Medicine (Licence: GA 67289) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2020-11-24 |