| NPI | 1477710648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 54239) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 93125) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2025-10-24 |