| NPI | 1871848846 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MN 57333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 253114) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2018-04-12 |