| NPI | 1376995704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 63883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 29078) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2021-09-16 |