| NPI | 1447339460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI DW050762) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301050762) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2018-02-03 |