| NPI | 1366735417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS122440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2772) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2014-08-29 |