| NPI | 1144224957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TN md24920) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 51171) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-03-12 |