| NPI | 1790724185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 23454) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 8165) |
| 207R00000X Internal Medicine (Licence: CA A60180) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2013-11-07 |