| NPI | 1215373261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01079819A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-43234) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2021-01-26 |