| NPI | 1548227978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2013-00605) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.15384R) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2013-08-05 |