| NPI | 1528136827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 208961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME67418) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-09-15 |