| NPI | 1053310607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD22137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D23677) |
| Enumeration Date | 2005-07-16 |
| Last Update Date | 2017-07-14 |