| NPI | 1134315823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME26212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME26212) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2023-09-18 |