| NPI | 1346478088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 252341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301093949) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2016-04-05 |