| NPI | 1184645657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 018742) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 66785) |
| 207R00000X Internal Medicine (Licence: NC 2012-00891) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-11-04 |