| NPI | 1124056072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2013-00354) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 28580) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2014-04-07 |