| NPI | 1073595682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA c55035) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 235605) |
| 207R00000X Internal Medicine (Licence: TN MD40703) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2019-03-11 |