| NPI | 1255340527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 39678) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 30078) |
| 207R00000X Internal Medicine (Licence: NC 2007-00147) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-12-30 |