| NPI | 1336112895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 16248) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 016248) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2013-05-13 |