| NPI | 1003813601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R9H10) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO R9H10) |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2020-04-16 |