| NPI | 1821253899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 48753) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.204060) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2015-09-29 |