| NPI | 1841312568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A93752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101238420) |
| 207R00000X Internal Medicine (Licence: DC MD034639) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |