| NPI | 1740398064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 15791) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD050198L) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2013-07-22 |