| NPI | 1720062060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148610) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 22923) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2021-02-11 |