| NPI | 1871881466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 20140160) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt200577) |
| Enumeration Date | 2011-07-16 |
| Last Update Date | 2017-03-17 |