| NPI | 1649224643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D50534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101038350) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2017-09-30 |