| NPI | 1528045606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0052245) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D52245) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-08-21 |