| NPI | 1114148137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-8656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 19738) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2014-07-01 |