| NPI | 1144491655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 34266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME55986) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2011-03-30 |