| NPI | 1083676266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 36721) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC DO36721) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2016-07-27 |