| NPI | 1538109475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 56026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A79255) |
| 207R00000X Internal Medicine (Licence: NC 200700779) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-08-09 |