| NPI | 1912984485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS8528) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL FL00OS8528) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2023-05-01 |