| NPI | 1720216963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD158190) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 240789) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2014-01-27 |