| NPI | 1114940129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL D0590) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL D0590) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2017-07-20 |