| NPI | 1003136367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01077384A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 25429) |
| 207R00000X Internal Medicine (Licence: MI 4301096387) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-11-01 |