| NPI | 1538322474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 005538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 41716) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2013-09-26 |