| NPI | 1871737643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD444380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101251130) |
| 207R00000X Internal Medicine (Licence: NM MD2013-0087) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2013-04-11 |