| NPI | 1134175938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 035972) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME79089) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2023-02-06 |