| NPI | 1073557583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: UT 3099134-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY 7074A) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-11-27 |