| NPI | 1891997961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 42968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 104853) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2026-03-09 |