| NPI | 1891708426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 242399) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 39639) |
| 207R00000X Internal Medicine (Licence: SD 4391) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2013-06-06 |