| NPI | 1396756581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102202712) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2003007031) |
| 207R00000X Internal Medicine (Licence: TN DO1767) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2015-01-15 |