| NPI | 1659483949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD016704) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 12425) |
| 207R00000X Internal Medicine (Licence: VA 45058) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-09-01 |