| NPI | 1366431710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 45430) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME78116) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2022-03-26 |