| NPI | 1376592584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 234278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD068226L) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2008-02-19 |