| NPI | 1467421065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD C25373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0025373) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2010-08-17 |