| NPI | 1104025329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 50393) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 242195) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2022-03-22 |