| NPI | 1891889481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 5144a) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2002026162) |
| 207R00000X Internal Medicine (Licence: ID m-9139) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-09-18 |