| NPI | 1841305331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101243352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 32455) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-08-02 |