| NPI | 1144410879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 41419) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2002-01428) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2007-07-30 |