| NPI | 1164758082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS11009) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO1852) |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2011-06-22 |