| NPI | 1992760581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200000171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 51287) |
| 207R00000X Internal Medicine (Licence: SC 23016) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2017-12-21 |