| NPI | 1770554982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 47972) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200400663) |
| 207R00000X Internal Medicine (Licence: SC 31318) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-10-11 |