| NPI | 1447281308 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0064651)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D64651)  | 
| 208D00000X General Practice (Licence: MD D64651)  | |
| Enumeration Date | 2006-07-06 | 
| Last Update Date | 2021-10-05 |