| NPI | 1891030268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0084520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101259016) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2018-02-16 |