| NPI | 1235486192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 286263) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01079499A) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2021-05-21 |