| NPI | 1356504856 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 51005) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP181) | 
| 207R00000X Internal Medicine (Licence: TN 510005) | |
| Enumeration Date | 2008-07-03 | 
| Last Update Date | 2025-03-14 |