| NPI | 1801035969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR C-10897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 26821) |
| Enumeration Date | 2009-02-13 |
| Last Update Date | 2018-04-13 |