| NPI | 1568445435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 26810) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 026810) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2017-01-19 |