| NPI | 1023302593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2015-00213) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT014170) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2016-07-14 |