| NPI | 1609841444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 200000810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 059916) |
| 207Q00000X Family Medicine (Licence: NC 200000810) | |
| 207R00000X Internal Medicine (Licence: NC 200000810) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2023-03-20 |