| NPI | 1538385091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 44341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP00025) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2012-05-02 |