| NPI | 1619103553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-16489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MDR-5671) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2012-04-19 |