| NPI | 1053379644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01066525A) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 35131) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-03-07 |