| NPI | 1740352798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301048291) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301048291) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |