| NPI | 1821082603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 22262) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 36010) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2015-02-19 |