| NPI | 1548240716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0066086) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101236809) |
| 208D00000X General Practice (Licence: MD D0066086) | |
| Enumeration Date | 2006-01-22 |
| Last Update Date | 2013-12-16 |