| NPI | 1346205010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R8J39) |
| 207R00000X Internal Medicine (Licence: MO R8J39) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2020-07-07 |