| NPI | 1609848373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 012503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 12503) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2010-06-30 |