| NPI | 1073616652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0032224) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D32224) |
| 207R00000X Internal Medicine (Licence: MD D0032224) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2017-04-10 |