| NPI | 1538199088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-107253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 48156) |
| 207R00000X Internal Medicine (Licence: MI 4301083064) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-09-22 |