| NPI | 1376582049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 13458) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 13458) |
| 208000000X Pediatrics (Licence: AL 13458) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2018-10-26 |