| NPI | 1952408122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A60637) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A60637) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: CA A60637) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-11-03 |