| NPI | 1942283429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME105191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301071373) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2012-10-12 |