| NPI | 1013969583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7713) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS7713) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-08-17 |