| NPI | 1497207096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 27285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 020705) |
| Enumeration Date | 2016-10-29 |
| Last Update Date | 2016-10-29 |