| NPI | 1861451866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD33582) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101054466) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2007-07-08 |