| NPI | 1235121237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MD38409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 044043) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2018-07-12 |