| NPI | 1568727238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60819263) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01074664A) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2020-12-01 |