| NPI | 1447301825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301094728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 53160-020) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2011-09-20 |