| NPI | 1518272228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D91358) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004378) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2022-01-31 |