| NPI | 1134254147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD30729) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 226071) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |