| NPI | 1922009638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 033402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 033402) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-11-12 |