| NPI | 1225367956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI L1645369) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI L1645370) |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2009-12-08 |