| NPI | 1699743021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 22943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00022943) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2015-09-01 |