| NPI | 1609254267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101277657) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 57752) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2024-06-30 |