| NPI | 1104897164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 47247) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC TL29424) |
| 207R00000X Internal Medicine (Licence: GA 054775) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2018-10-25 |