| NPI | 1053300913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 9037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 243291) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2011-08-23 |