| NPI | 1750619672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301095489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.124119) |
| Enumeration Date | 2009-12-04 |
| Last Update Date | 2009-12-06 |