| NPI | 1629490172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101255466) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101255466) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |