| NPI | 1407137375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301099664) |
| Additional Taxonomies | 261QE0002X Clinic/Center Emergency Care |
| 261QP2300X Clinic/Center Primary Care | |
| 282E00000X Long Term Care Hospital | |
| 282N00000X General Acute Care Hospital (Licence: MI 4301099664) | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2018-05-17 |