| NPI | 1275793309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 016820) |
| Additional Taxonomies | 281P00000X Chronic Disease Hospital (Licence: PR 16820) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2014-07-10 |