| NPI | 1225230642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD - 15202) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GU M - 1654) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2010-05-27 |