| NPI | 1518309566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 17689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-062995) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2014-07-09 |