| NPI | 1053537167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS 10652) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315027562) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2010-02-08 |