| NPI | 1548674815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 77316) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 390200000X.) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2025-02-07 |