| NPI | 1508067109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 73403) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 048995) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2010-09-28 |