| NPI | 1578533055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 14878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101036348) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2014-06-06 |