| NPI | 1780818039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 15962) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 45200) |
| 207R00000X Internal Medicine (Licence: MI 4301099571) | |
| 207R00000X Internal Medicine (Licence: MN 1507) | |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2011-11-07 |