| NPI | 1275663247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR 10160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD10106) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2024-08-29 |