| NPI | 1770564395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 10759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 10759) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2023-05-23 |