| NPI | 1013015635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000013395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 09878) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-07-22 |