| NPI | 1295141810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 260579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01088932A) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-02-08 |