| NPI | 1861567133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VI 1001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 355998-1205) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |