| NPI | 1295827871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 21421) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 21421) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2019-05-23 |