| NPI | 1255302428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS 9078) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 055526) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2007-07-08 |