| NPI | 1053765149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 12450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32424) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2016-04-15 |