| NPI | 1851361836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD5859) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101014961) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-11-03 |