| NPI | 1104830710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR C-6365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000017236) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2013-06-20 |