| NPI | 1710218896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA VA0101233498) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD21917) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2010-03-18 |