| NPI | 1144400839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 60847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 001300) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2013-03-25 |