| NPI | 1831345008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 12281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101243047) |
| 207R00000X Internal Medicine (Licence: DC MD037135) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2019-04-22 |