| NPI | 1558504357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A136139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 46427) |
| 207R00000X Internal Medicine (Licence: AZ 46427) | |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2019-06-28 |