| NPI | 1326097627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301091096) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18781) |
| 207R00000X Internal Medicine (Licence: MI 4301091096) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2022-04-27 |