| NPI | 1689968943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD165899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098724) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2014-08-11 |