| NPI | 1588930234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0080112) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD042631) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2019-06-11 |