| NPI | 1740461011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 45849) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101245845) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2014-12-16 |