| NPI | 1417923160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 036002) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME121844) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2017-10-13 |