| NPI | 1912092024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD14733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101055766) |
| 207R00000X Internal Medicine (Licence: TN 14733) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-06-06 |