| NPI | 1366489973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 151321) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 49503) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-06-18 |