| NPI | 1194745489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: MD D0076113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22091) |
| 207R00000X Internal Medicine (Licence: MD D007613) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-11-07 |