| NPI | 1922650621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 67874) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 0000067874) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2023-06-27 |