| NPI | 1477858116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 074384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2391) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2017-06-01 |