| NPI | 1942537725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA os015176) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA ot012185) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2016-02-10 |