| NPI | 1952507055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301082562) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301082562) |
| 208000000X Pediatrics (Licence: MI 4301082562) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2024-02-14 |