| NPI | 1962781146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101256135) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MT 200477) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2014-06-13 |