| NPI | 1467707034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 1250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A6294) |
| 207R00000X Internal Medicine (Licence: NJ 25MB04750200) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-07-20 |