| NPI | 1003907098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 18838) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 21815) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2018-07-20 |