| NPI | 1639174105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.11458R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 11458R) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2018-10-22 |