| NPI | 1104182641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 23848) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-13941) |
| 207R00000X Internal Medicine (Licence: TN 52692) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2021-02-22 |