| NPI | 1629172184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 79241) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01062267A) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2024-09-04 |