| NPI | 1881614584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 43715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 043715) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-06-05 |