| NPI | 1366520298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 024146) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 024146) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-11-18 |