| NPI | 1104808757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 025449) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 025449) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2011-09-21 |