| NPI | 1821301110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A117984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A117984) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2026-01-07 |