| NPI | 1457665846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101263718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101263718) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2022-07-13 |