| NPI | 1225008717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 342382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101255875) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2014-05-30 |