| NPI | 1538508304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101264249) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18867) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2018-06-14 |