| NPI | 1649487893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101016738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL os 10715) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-03-21 |