| NPI | 1164608519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 49212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 058845) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2015-03-30 |