| NPI | 1194745489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2009-01140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22091) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2013-04-09 |