| NPI | 1386910222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0033711) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX TM00190) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2012-03-27 |