| NPI | 1043209125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME77208) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME77208) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2013-02-22 |