| NPI | 1154435279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 17722) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 17722) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2016-05-05 |