| NPI | 1770584898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 13669) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 13669) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2011-06-07 |