| NPI | 1245527316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 055299) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD449442) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2016-06-16 |