| NPI | 1508015512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 46563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 64348) |
| 207R00000X Internal Medicine (Licence: KY 52988) | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2020-01-08 |