| NPI | 1316047400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 33839) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 033839) |
| 208D00000X General Practice (Licence: GA 33839) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-07-31 |