| NPI | 1346288263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 2329A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 6350) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2011-10-05 |