| NPI | 1962667675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 204671) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 149509) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2012-03-21 |