| NPI | 1073642625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0020986) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD12438) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-05-31 |