| NPI | 1033203591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 14304A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY TL6875) |
| 207R00000X Internal Medicine (Licence: MT 10370) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-08-19 |