| NPI | 1023767225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 6370) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2023-02508) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-06-09 |