| NPI | 1194336800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 284818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01089442A) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2023-07-17 |