| NPI | 1528102936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 42340) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 11085) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2007-07-08 |