| NPI | 1366507857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 12803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD 12803) |
| 207R00000X Internal Medicine (Licence: MD D0025812) | |
| 208VP0000X (Licence: HI 12803) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2018-03-23 |