| NPI | 1194785899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9400873) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 94-00873) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2021-03-17 |