| NPI | 1881914083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 27090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6420) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2016-05-26 |