| NPI | 1417957424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 54047) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0007645) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2014-02-10 |