| NPI | 1013020577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC md32755) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD d0056687) |
| 207R00000X Internal Medicine (Licence: VA 0101239613) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |