| NPI | 1760462725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9600902) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 9600902) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2016-01-06 |