| NPI | 1184606279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 10328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 172907-1205) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2011-10-03 |