| NPI | 1689713315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 4965) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 4965) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2016-10-18 |