| NPI | 1972658078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.205481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 232540) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2013-01-08 |