| NPI | 1871716027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 108735) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-098811) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |