| NPI | 1487760989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 017364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD017364) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2019-06-24 |