| NPI | 1376697250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 18174) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 34443) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |