| NPI | 1669620373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01072348A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096480) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2022-10-11 |