| NPI | 1164475158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01021660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01021660A) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-04-01 |