| NPI | 1598745119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME78380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 34201-020) |
| 207R00000X Internal Medicine (Licence: MN 33480) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2012-02-03 |