| NPI | 1548218100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 277584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2003-0249) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-02-07 |