| NPI | 1902848021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD 9170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D17191) |
| 207R00000X Internal Medicine (Licence: VA 29939) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-05-02 |