| NPI | 1982690129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9800448) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 175570) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2013-08-21 |