| NPI | 1588899082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 45242) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301093426) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2012-02-15 |