| NPI | 1528297108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME36056) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 23648) |
| Enumeration Date | 2009-07-05 |
| Last Update Date | 2009-07-05 |