| NPI | 1205040011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 4596) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |