| NPI | 1215037932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 20308) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 20308) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2012-05-21 |