| NPI | 1558367243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ACN450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15309) |
| 207Q00000X Family Medicine (Licence: FL ACN450) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2013-11-14 |