| NPI | 1336420553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 62573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01073984A) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2020-12-04 |