| NPI | 1083668172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MO 2009015805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 39589) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2009-06-23 |