| NPI | 1811985815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 28537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 22875) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2023-03-07 |