| NPI | 1417060666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 20650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 20650) |
| 208D00000X General Practice (Licence: AL 20650) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2013-09-24 |