| NPI | 1003887183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 19297) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 42826) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2018-03-06 |