| NPI | 1245228584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 8941) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 8941) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2015-11-06 |