| NPI | 1972723765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000042236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2006028227) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-03-07 |