| NPI | 1023345972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01061542A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101245863) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2012-09-25 |