| NPI | 1265502389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0051520) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101052350) |
| 207R00000X Internal Medicine (Licence: MD D0051520) | |
| 208D00000X General Practice (Licence: DC MD21812) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2018-12-19 |