| NPI | 1629093547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 12716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 203582) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |