| NPI | 1871722066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD047414) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME119461) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2020-05-10 |