| NPI | 1982608568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A38329) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD-3715) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A38329) | |
| 208000000X Pediatrics (Licence: CA A38329) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2023-08-03 |