| NPI | 1518044577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 7344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 7344) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-09 |