| NPI | 1407125800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 83563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 33648) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2020-02-04 |