| NPI | 1477556157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD 31352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101221401) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2009-09-22 |