| NPI | 1477506160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MD32658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 32658) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-04-06 |