| NPI | 1083629968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: DC MD30689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC md30689) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2014-01-28 |