| NPI | 1831458298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101255241) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101255241) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2015-08-24 |