| NPI | 1699855908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4101014136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101014136) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2025-03-21 |