| NPI | 1699880534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 21043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS MS15817) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2018-10-05 |