| NPI | 1194762849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-27892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 27892) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2018-05-09 |