| NPI | 1972653152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TN 12189) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: VA 0101254986) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TN 12189) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IN 010256520A) | |
| 208000000X Pediatrics (Licence: TN 12189) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2021-10-12 |