| NPI | 1619034188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M4140) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M4140) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-07-08 |