| NPI | 1760531149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME52258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME52258) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-04-28 |