| NPI | 1336485226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD06841) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC AV15GOB32) |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2012-12-20 |