| NPI | 1710080999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 22638) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 22638) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2007-10-10 |