| NPI | 1174628523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD-019687) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: TN MD-019687) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2018-03-22 |