| NPI | 1568420628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL PA-154) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.154) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-04-04 |