| NPI | 1487624615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 11559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 11559) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2017-03-02 |