| NPI | 1942250758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 22826) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 22826) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-03-31 |