| NPI | 1538549977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-21745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 60590) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2021-08-04 |