| NPI | 1326477092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D62310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 37985) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2013-11-04 |