| NPI | 1952535452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-00616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2012-00616) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2023-08-09 |