| NPI | 1497904346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 046516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 046516) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CT 046516) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2017-03-09 |