| NPI | 1407820400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 13415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 12632) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2017-01-19 |