| NPI | 1912140351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 14333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 12173) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2019-04-01 |