| NPI | 1962620401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 055613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME93723) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2014-02-11 |