| NPI | 1972580744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO448) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL DO-448) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2019-09-25 |