| NPI | 1306907738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 11011) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 106241) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2017-03-14 |