| NPI | 1063649465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A137497) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A137497) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2015-10-27 |