| NPI | 1215134408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301089193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301089193) |
| 208D00000X General Practice (Licence: MI 4301089193) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2011-08-08 |