| NPI | 1619025780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 27010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD020458) |
| 207R00000X Internal Medicine (Licence: AZ 19251) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2013-01-15 |