| NPI | 1568422061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2004-0055) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2004-0055) |
| 207R00000X Internal Medicine (Licence: NM MD2004-0055) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2025-03-06 |