| NPI | 1790747251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0069728) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MO R8E93) |
| 207R00000X Internal Medicine (Licence: MO R8E93) | |
| 207Q00000X Family Medicine (Licence: MD D0069728) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2010-01-22 |