| NPI | 1063679827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 44474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-050529) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2021-08-23 |