| NPI | 1336254820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-094166) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 16748) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2012-10-30 |