| NPI | 1487619888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01044505A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 32483) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2019-08-15 |