| NPI | 1700868890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9701362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9701362) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2013-07-09 |