| NPI | 1376805192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 77573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS017152) |
| 207R00000X Internal Medicine (Licence: PA OT014444) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2019-05-01 |