| NPI | 1174740096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0042675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD034542) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-07-08 |