| NPI | 1285627471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 35965-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 35965-020) |
| 208600000X Surgery (Licence: WI 39565-020) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2009-12-28 |