| NPI | 1497839070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101256885) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 43425) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-01-10 |