| NPI | 1063726792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 47803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R72059) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2014-01-30 |