| NPI | 1750486155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS8694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 058694) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2011-03-02 |