| NPI | 1346508330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 28024) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 16360) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2012-04-26 |