| NPI | 1245433291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-01767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY TL1334) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2022-05-11 |