| NPI | 1205270535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 55763) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 55763) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2018-05-17 |