| NPI | 1073537643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 309875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 336055662) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-01-31 |