| NPI | 1780645960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 36379) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MO 36379) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-11-19 |