| NPI | 1972708667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000044858) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.201367) |
| 208000000X Pediatrics (Licence: LA MD.201367) | |
| 208000000X Pediatrics (Licence: TN MD0000044858) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2010-01-27 |