| NPI | 1962692939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 1869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116016687) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2008-12-19 |