| NPI | 1629039714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: MO 108214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 108214) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2007-07-08 |