| NPI | 1386765832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 1880) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101016171) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2018-03-08 |