| NPI | 1811905961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 220686) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 12534) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2015-12-01 |