| NPI | 1689630691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200300167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200300167) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: NC 200300167) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NC 200300167) | |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NC 200300167) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-04-18 |