| NPI | 1558629907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 2765) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204175) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2020-04-28 |