| NPI | 1770774754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 44031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301090986) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2010-01-05 |