| NPI | 1720061906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 23094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 023094) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2017-01-23 |