| NPI | 1598786782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0026677) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD15621) |
| 207R00000X Internal Medicine (Licence: VA 0101030624) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2007-07-08 |