| NPI | 1508429960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301507431) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 2284-320) |
| 207R00000X Internal Medicine (Licence: MI 4301507431) | |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2023-12-27 |