| NPI | 1760562433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 15705) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR DEA BC9442649) |
| 207R00000X Internal Medicine (Licence: PR DM-15863-4) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2014-07-21 |