| NPI | 1376802611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 006831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101019668) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2016-07-05 |