| NPI | 1710161104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 16963) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16963) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2019-12-20 |