| NPI | 1831345529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 005635) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL0575) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2016-08-03 |