| NPI | 1346200300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 208697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 11167) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2011-12-27 |