| NPI | 1083934533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 12067) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA r8917) |
| 207R00000X Internal Medicine (Licence: MN 56327) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2022-07-26 |