| NPI | 1831292614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA os-006113-l) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA os-006113-l) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2016-03-23 |