| NPI | 1497922389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0055643) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME89694) |
| Enumeration Date | 2008-05-11 |
| Last Update Date | 2008-05-11 |