| NPI | 1235334400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 18138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 201418) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2011-06-20 |