| NPI | 1306851720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 028629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 028629) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2021-11-10 |