| NPI | 1568455665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 22906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 60162) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2014-02-03 |