| NPI | 1114928835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-072335) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301049152) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2016-03-10 |