| NPI | 1134389588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 82245) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 207R00000X) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2019-02-14 |