| NPI | 1972546976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A78927) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A78927) |
| 207Q00000X Family Medicine (Licence: CA A78927) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-03-23 |