| NPI | 1518370410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD047860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD462266) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-11-20 |