| NPI | 1033188073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 27778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R8F27) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2014-03-12 |