| NPI | 1316387319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2016024019) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103597) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2016-08-16 |