| NPI | 1952424848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 46373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 11435) |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2007-07-08 |