| NPI | 1992773147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 11854) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11854) |
| Enumeration Date | 2006-03-12 |
| Last Update Date | 2017-04-05 |