| NPI | 1114982444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 102498) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: FL 102498) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2011-07-11 |