| NPI | 1164696878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD042897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 226152) |
| 207R00000X Internal Medicine (Licence: CT 226152) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2015-05-21 |