| NPI | 1902007669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME038105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G00035039) |
| 207R00000X Internal Medicine (Licence: WV 437699) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2015-03-16 |