| NPI | 1902888092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 31465) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 31465) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2011-07-11 |