| NPI | 1912018557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101049986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C148939) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-05-19 |