| NPI | 1205865813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 27800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000013321) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-07-08 |