| NPI | 1235375924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 15941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01025648A) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2014-11-20 |