| NPI | 1366750002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ MD-36425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.015682) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2010-09-15 |