| NPI | 1134215510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042.0012547) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 0101053970) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2019-02-22 |