| NPI | 1083616833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 55991) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 039791) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2018-10-24 |