| NPI | 1588907943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 66533) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 176642) |
| 207R00000X Internal Medicine (Licence: MD 8889) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2023-05-31 |