| NPI | 1447657556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 73009) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 175951) |
| 207R00000X Internal Medicine (Licence: VA 0101043842) | |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2014-12-04 |