| NPI | 1194804161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60344899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH RT-1351) |
| 207R00000X Internal Medicine (Licence: WY TL1017) | |
| 207R00000X Internal Medicine (Licence: NH 13498) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-10-07 |