| NPI | 1942407226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS10691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2011-01564) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2015-11-16 |