| NPI | 1366682239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2011021601) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT192795) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2012-01-18 |