| NPI | 1528020419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 12362) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PR 12362) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2011-01-20 |