| NPI | 1124099163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0020099) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0020099) |
| 208D00000X General Practice (Licence: MD D0020099) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2011-10-11 |