| NPI | 1720100670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301053468) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301053468) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-16 |