| NPI | 1568475515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 25696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 25696) |
| 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: GA 25696) | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: GA 25696) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |