| NPI | 1225078660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 40509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2000157963) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2008-09-11 |