| NPI | 1811150915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-15796) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 51340) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2022-04-27 |