| NPI | 1366725749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME114732) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 266339) |
| 207R00000X Internal Medicine (Licence: VA 0101252539) | |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2014-08-13 |