| NPI | 1740254713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C55979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME92300) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2018-09-21 |