| NPI | 1053352740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 58026) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000032003) |
| 207R00000X Internal Medicine (Licence: SC TL28808) | |
| 207R00000X Internal Medicine (Licence: VA 0101239536) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2012-06-22 |