| NPI | 1053402263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 045352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH RT1377) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2016-08-06 |