| NPI | 1073539300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 15060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 19928) |
| 122300000X Dentist (Licence: LA 3309) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2018-05-03 |