| NPI | 1013279926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101255398) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101255398) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2022-08-24 |