| NPI | 1992707236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 05751R) |
| Additional Taxonomies | 171W00000X Contractor (Licence: LA 05751R) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2012-05-24 |