| NPI | 1669443065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 058080) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 0s8462) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2019-03-03 |