| NPI | 1699771022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 41101) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 41101) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2023-09-12 |