| NPI | 1467613356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 049979) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 49979) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2021-04-29 |