| NPI | 1730262114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000042450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.204419) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-06-15 |