| NPI | 1235110321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1582369) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1582369) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2011-03-02 |