| NPI | 1104884352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.10898R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 10898R) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2015-04-21 |