| NPI | 1205361292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 27609) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01068041A) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-12-09 |