| NPI | 1124259775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 250081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 240706) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2012-08-01 |