| NPI | 1073006946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 63550) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 010108) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2021-08-12 |