| NPI | 1548265838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: GA 047049) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: GA 047049) |
| 207R00000X Internal Medicine (Licence: GA 047049) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2025-09-04 |