| NPI | 1003867151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR R-4724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 10673) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2017-01-26 |