| NPI | 1679558738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 44499) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 41372) |
| 207R00000X Internal Medicine (Licence: IA 35519) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2023-05-17 |