| NPI | 1992865752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 068706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD30439) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2013-07-16 |