| NPI | 1346259280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 38948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 38948) |
| 207R00000X Internal Medicine (Licence: NC 35141) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2018-05-14 |