| NPI | 1013978790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD 0053235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 31761) |
| 207R00000X Internal Medicine (Licence: VA 0101840502) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2011-09-08 |