| NPI | 1992812325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 15761) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: WI 15761) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2019-04-23 |