| NPI | 1013276898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AK 11023) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102203678) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2019-06-18 |