| NPI | 1366681843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 62770) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA 62770) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2010-10-07 |