| NPI | 1487685749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 37067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 37067) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-09-12 |