| NPI | 1639497779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 53932) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2014-0710) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2024-05-17 |