| NPI | 1104098995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-01657) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 002551) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2011-08-03 |