| NPI | 1265429203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 60938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0073520) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2025-07-31 |