| NPI | 1902943764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 19602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 33653) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-11-28 |