| NPI | 1235240516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 22660) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: AL 22660) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-12-11 |