| NPI | 1326238080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 40729) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: VA 0101236135) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2012-10-26 |