| NPI | 1215519095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 74171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116035502) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2025-08-07 |