| NPI | 1972564136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D19502) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D19502) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2007-11-21 |