| NPI | 1679599922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 35471) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD35471) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-09-29 |