| NPI | 1164645362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN S0921) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2009-01346) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2021-03-31 |