| NPI | 1306100789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 2917) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204224) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2023-11-28 |