| NPI | 1508856139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD8784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000008784) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2021-05-21 |