| NPI | 1154697514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD59529) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD59529) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2023-08-20 |