| NPI | 1003135328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 58191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 106796) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2024-06-13 |