| NPI | 1558399766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA OS006763-L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS-006763-L) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2011-11-15 |