| NPI | 1518942515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 73718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 73718) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2013-06-10 |