| NPI | 1629186689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 2061679) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 34025) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-12-27 |