| NPI | 1710057047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD41977t) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 7752) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2009-09-16 |