| NPI | 1265537104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2003015828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01066023A) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2017-12-18 |