| NPI | 1881753838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 00-28251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101-034672) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2016-04-29 |