| NPI | 1477548469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 22570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 22570) |
| 207R00000X Internal Medicine (Licence: AL 00022570) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2019-05-08 |