| NPI | 1639319080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 52457) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME52232) |
| 207R00000X Internal Medicine (Licence: VA 0101258301) | |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2022-10-14 |