| NPI | 1871956284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD d92937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101264864) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2022-10-04 |