| NPI | 1811183965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 20582) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 20582) |
| Enumeration Date | 2007-09-22 |
| Last Update Date | 2013-07-11 |