| NPI | 1356587554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2006-01804) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2006-01804) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2020-07-10 |