| NPI | 1629271929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 048043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 19687) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |