| NPI | 1568450682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 27204) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 27204) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-12-22 |