| NPI | 1386869956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD000047216) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD0000047216) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2019-08-07 |