| NPI | 1558351551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-8183) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M8183) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2024-04-24 |