| NPI | 1538457221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102203988) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA ot014360) |
| 207Q00000X Family Medicine (Licence: VA 0102203988) | |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2023-02-23 |