| NPI | 1770607228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 33315) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 33315) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2017-01-18 |