| NPI | 1811563059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 74095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1018076) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2025-08-20 |