| NPI | 1689679409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 26187) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 26187) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2010-09-08 |