| NPI | 1962688713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301100852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 002733) |
| 207R00000X Internal Medicine (Licence: TN 46731) | |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2012-08-02 |