| NPI | 1336246305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D73006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD041830L) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-11-05 |