| NPI | 1841452471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102202588) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA student) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2013-11-07 |