| NPI | 1275573222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 00021808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00021808) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2014-05-02 |