| NPI | 1407932015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101240955) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD036241) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2010-09-01 |