| NPI | 1720098551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301032493) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301032493) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2012-11-14 |