| NPI | 1972554475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 52586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 115677) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2015-04-07 |