| NPI | 1902399561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-01061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 34884-r) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2022-01061) | |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2024-02-12 |