| NPI | 1003072810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 25439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098054) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2024-05-14 |