| NPI | 1851621064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AK MEDS7869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 11726) |
| 207R00000X Internal Medicine (Licence: NY 258429) | |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2018-07-30 |