| NPI | 1376807990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A136635) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252558) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2015-12-11 |