| NPI | 1215224902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 2674) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102203493) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2017-02-01 |