| NPI | 1972683639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-041790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036041790) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-07-22 |