| NPI | 1154505931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.202191) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA MD.202191) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2015-04-28 |