| NPI | 1730171521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101239405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200500866) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2019-03-29 |