| NPI | 1891718763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 023016) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 23016) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2010-05-01 |