| NPI | 1679592877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI FD085126) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301085126) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2014-12-22 |