| NPI | 1629040407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 70-208) |
| Additional Taxonomies | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: NM 70-208) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2007-07-09 |