| NPI | 1205182508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO 1488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV ED0291A) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2015-10-27 |