| NPI | 1720163066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 206945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036096703) |
| 207R00000X Internal Medicine (Licence: AL 30434) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2015-03-12 |