| NPI | 1568695955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN M.D.1732) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 17064) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2013-04-02 |