| NPI | 1245679364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 25242) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 390200000) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2017-12-11 |