| NPI | 1679578835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D 47156) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D 47156) |
| 207R00000X Internal Medicine (Licence: DC MD 21355) | |
| 208D00000X General Practice (Licence: DC MD 21355) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2008-05-13 |