| NPI | 1881748168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME80777) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000027776) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2011-01-19 |