| NPI | 1831418276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: KS 0438096) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-8853) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2015-08-26 |