| NPI | 1245290048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD15257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 15257) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2023-09-06 |