| NPI | 1033527353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D83654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207365) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2017-09-21 |