| NPI | 1487674644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 030100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-3450) |
| 207R00000X Internal Medicine (Licence: MS 12820) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-05-22 |