| NPI | 1467441253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 216431) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 216431) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2017-04-10 |