| NPI | 1386610764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301082559) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302030359) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2015-08-13 |