| NPI | 1821272014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 61962) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 047787) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2014-05-23 |