| NPI | 1982888376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR OR01379) |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: PA MA053309) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2014-02-18 |