| NPI | 1114086451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 35632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 57187) |
| 207R00000X Internal Medicine (Licence: HI 14859) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2008-07-30 |