| NPI | 1144457805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101018143) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101018143) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2024-01-29 |