| NPI | 1871805986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS016858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA ot013829) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2014-02-28 |