| NPI | 1023052024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.014468) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: IL 036-114723) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-10-01 |