| NPI | 1457336349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101231184) |
| 207R00000X Internal Medicine (Licence: PA MD063953L) | |
| 207R00000X Internal Medicine (Licence: NV 10193) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2007-07-08 |