| NPI | 1366756447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 61351) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT197709) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2018-10-05 |