| NPI | 1962674341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301088461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088461) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2022-07-22 |