| NPI | 1225359268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01072051A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101247767) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2021-02-08 |