| NPI | 1376612945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD11277) |
| Additional Taxonomies | 174400000X Specialist (Licence: ME 011277) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-06-09 |