| NPI | 1457655979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-41633) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R9042) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2014-03-15 |