| NPI | 1174597660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000029338) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 29338) |
| 208000000X Pediatrics (Licence: TN 29338) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-04-13 |