| NPI | 1588759211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 3238) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 003238) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-09-05 |