| NPI | 1851316236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301062272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 6056A) |
| 207R00000X Internal Medicine (Licence: OR MD27811) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-01-20 |