| NPI | 1922444363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 54605) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN FW6236625) |
| 207R00000X Internal Medicine (Licence: FL ME142514) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2020-09-01 |