| NPI | 1578710141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200801349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2008-01349) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2021-08-03 |