| NPI | 1275119190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 3654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 4924) |
| 207R00000X Internal Medicine (Licence: TN 4924) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2024-09-03 |