| NPI | 1467779546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM 90-247) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM 90-247) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2010-04-28 |