| NPI | 1255393948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WV 02039) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 02039) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2014-05-22 |