| NPI | 1750624920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A153289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A153289) |
| 208000000X Pediatrics (Licence: CA A153289) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2023-09-07 |