| NPI | 1255454567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D39096) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD17786) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2018-08-20 |