| NPI | 1629019922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 42101) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 16845) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2008-03-20 |