| NPI | 1588158109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101272901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301114569) |
| 207Q00000X Family Medicine (Licence: MI 4351034175) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2021-08-18 |